Senior Reimbursement Analyst

Opelousas General Health System • Opelousas, LA

82d

About The Position

The Senior Reimbursement Analyst plays a key role in ensuring the financial integrity and compliance of the hospital’s reimbursement operations. This position is responsible for analyzing payer contracts, auditing claim payments, identifying reimbursement variances, and developing educational tools to support revenue cycle optimization. The analyst serves to improve payment accuracy and streamline processes through data-driven insights.

Requirements

• Minimum of 10 years of progressive experience in healthcare reimbursement, revenue integrity, or payer analysis.
• Strong knowledge of payer contracts, reimbursement methodologies, and claims auditing.
• Proficiency with SQL, Microsoft Excel, and EHR/revenue systems (e.g., eClinicalWorks, Centricity, E-MDs).
• Demonstrated ability to analyze data and translate findings into actionable financial insights.
• Experience developing and leading staff training programs.
• Excellent written and verbal communication skills, with proven attention to detail.

Nice To Haves

• Experience with UPL/FMP programs and Disproportionate Share Hospital (DSH) reporting.
• Prior experience working with hospital or physician group revenue cycle teams.
• Exposure to payer portals, variance reporting, and contract modeling tools.

Responsibilities

• Audit insurance payments to ensure compliance with payer contracts and identify payment variances for recovery.
• Research payer policy trends and regulatory changes; develop educational materials and presentations for internal staff.
• Prepare reimbursement projections, financial impact analyses, and payer performance reports for leadership review.
• Support the preparation and submission of Upper Payment Limit (UPL) and Financial Management Plan (FMP) reports for disproportionate share hospitals.
• Maintain client and payer fee schedules, conduct rate-impact studies, and perform contract reviews to ensure reimbursement accuracy.
• Collaborate with programming and analytics teams to extract and validate financial data using SQL and other reporting tools.
• Serve as a subject matter expert for payer audits, denial trends, and reimbursement methodologies.
• Develop and maintain up-to-date educational resources regarding payer policy changes, particularly during periods of regulatory transition (e.g., COVID-19).
• Train and mentor new employees on payer guidelines, denial resolution, and claim accuracy standards.
• Communicate directly with payer representatives to resolve complex reimbursement and claim issues.

What This Job Offers

• Career Level: Senior
• Education Level: Bachelor's degree
• Number of Employees: 251-500 employees